Digital Edition

Wellness Programs on Trial

Carol Harnett is HRE’s benefits columnist. She is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily. She can be emailed at [email protected]

Now may be a good time to reflect upon the problems HR leaders are trying to address with wellness programs.

I’ve been involved in wellness in one way, shape or form my entire life. Raised by parents who believed life was a balance of work, love and play, I grew up with a rainbow of colors on my dinner plate, ballet lessons, bicycle rides, basketball and other childhood games, high expectations for doing my best in school and church on Sundays.

In hindsight, it’s not a surprise I gravitated toward combining my love of science and mathematics with physical activity and health. I ultimately found myself studying physiology and biophysics in graduate school, and accepting my first job as part of an interdisciplinary team that used science to maximize the performance of both elite athletes and the general public.

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It was during my first work experience that I encountered employees whose participation in our programs was subsidized by their employers. It was the late 1980s and the corporate world was dizzy with excitement about the possibilities associated with supporting a healthy workforce. Within relatively short order, we found ourselves placing these workers into one of two categories: the short-timers and the worried well. The short-timers lasted one to four weeks. No matter how often we worked with them to customize their health experience with us. The worried well were with us for life with no extra effort required.

I learned early on that corporate wellness initiatives largely served the worried well workers. There was absolutely nothing wrong with providing these individuals with programs to support their health, but it was also clear there was no health-cost savings from this initiative either.

So I was not surprised when recent headlines touted that workplace-wellness programs saved no money for employers, or at least after the first year of what is a four- to five-year prospective study called the Illinois Workplace Wellness Study. As WBUR summarized, this large-scale, randomized controlled trial found virtually zero benefits from a workplace-wellness program during its first year: no lower health costs, no fewer sick days, no extra trips to the gym, no rise in productivity.

And guess what? Employees who chose to participate in the workplace-wellness program were already healthier before the program began than those who did not. In other words, they were part of Team Worried Well.

There were, however, two positive findings in this sea of no impact. The first was that workers who joined the wellness program became likelier not only to seek screening for health issues but also to say they thought their employer placed a high priority on employees’ health.

The second positive finding was similar to one found in research I helped conduct on the impact of employee-assistance programs: Even when employees did not use the EAP, they were less likely to take sick days, and returned to work more quickly if they were out than workers whose employers did not offer an EAP.

It appears that a company’s decision to offer health-related programs is associated with employees having a more favorable opinion of their employers. (It is important to note that this is an association of circumstances and is not a cause-and-effect outcome.)

Another recent story in the New York Times summarized that preventive care only saved money in two circumstances: childhood immunizations and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were found to be cost-effective (meaning that they cost less than $50,000 to $100,000 per quality-adjusted life year gained).

The author of that piece cited many good arguments for increasing our focus on prevention, but they have nothing to do with saving money and everything to do with quality of life. This is no small outcome.

Given all of the above, I was somewhat astonished by the uproar heard across the country by employers and wellness vendors when John D. Bates, the federal judge presiding in the case of AARP v. Equal Employment Opportunity Commission, vacated the ruling that employers can offer incentives equal to up to 30 percent of the total cost of employee-only coverage to encourage workers to voluntarily participate in wellness programs. (Note: This ruling only applies to medical exams and certain types of inquiries such as those often used in health-risk assessments.)

I participated in a webinar on the implications of this decision in January and a number of people asked me to expand on this topic in this column. So I went back to my Businessolver hosts and asked Bruce Gillis, the company’s strategy practice leader of health, welfare and compliance, to provide further guidance for HR executives.

The judge’s decision can be a challenge for HR, benefits and wellness leaders who historically incorporate medical exams, biometric testing and health inquiries within their wellness initiatives. Unless the EEOC provides guidance faster than it previously indicated it could, Gillis says, employers will finalize their 2019 wellness-plan designs without additional direction. He suggests that, in the absence of this information, employers might consider the following options in planning their changes for 2019:

Add an alternative wellness option that does not require a biometric screening or ask health-status questions. These alternatives could take the form of education-oriented programs and can be positioned to earn an equivalent incentive as the biometric screening. This approach gives employees multiple paths to earn the incentive and makes participation in the screenings truly voluntary.

Some employers may choose to reduce the reward associated with participation in the biometric screenings or risk assessments. With additional guidance from the EEOC, Gillis notes, this may become a popular option. There was agreement from AARP that some level of incentive was acceptable, but without final direction from the EEOC it is difficult to predict what that acceptable level may be. (In the Illinois Workplace Wellness Study, a $100 incentive for participation appeared to be almost as good as a $200 reward in terms of spurring participation.)

Employers may choose to fully eliminate incentives within their wellness program while they await further guidance.

Employers could modify their programs such that the incentives employees earn are solely for non-biometric screening or risk-assessment programs. For example, programs that currently use blood screenings to detect the presence of nicotine may instead simply ask the employee if he or she is a tobacco user and adjust the premiums based on the response provided. In addition, a health-education program could be put in place that employees could choose to earn incentives without being required to answer questions about their individual health status.

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As always, employers should work with their advisors to determine a program that works within the evolving climate, while still allowing them to remain engaged in and supportive of their employees’ health and wellness.

I asked Rae Shanahan, Businessolver’s chief strategy officer, to comment on the AARP v. EEOC ruling as well, since she and I are often of similar minds when it comes to empathy and the workplace. True to form, Shanahan sees the disruption caused by this case as an opportunity for employers to re-evaluate the reasons they offer wellness programs.

“Let’s use ‘empathy’ as a verb and put it into practice,” Shanahan says. “The spirit and intent of the wellness exams, health-risk assessments and biometric screenings were good, yet it became mass- produced.”

When we deploy empathy and appreciate health literacy from employees’ perspective—and assume positive intent in their behaviors and choices—we can use this ruling to look at things differently. As Shanahan suggested, employees knowing their biometric numbers alone does not help employees to better navigate our healthcare system.

I will conclude by returning to something even more basic. We should use this time following the AARP v. EEOC decision to reflect upon the problems we were trying to address or solve with wellness programs. Most employers were aiming to reduce healthcare costs. Others were attempting to shift healthcare costs to their employees—especially if they didn’t participate in wellness programs. And still others wanted to improve employee productivity. But we can see from the disciplined design of the Illinois study that wellness programs don’t reduce healthcare costs or improve employee productivity.

If we use empathy, as Shanahan recommended, we will hear what employees have been telling us over the last 12 months. Employees want two things: flexibility, and paid leave for the care of their own health conditions and those of people for whom they care. Perhaps it’s time we incorporated those desires into our workplace-wellness design.

Three Ways AI Powers People-Driven Success

Employee satisfaction and engagement were rarely cited as key factors of organizational success 20 years ago, but today’s executives understand that people are the most powerful drivers of business performance. Gallup’s most recent State of the American Workplace report confirms that high engagement levels directly correlate with higher productivity, profitability and even sales, while simultaneously reducing turnover and absenteeism. Considering the substantial cost of replacing even a single upper-level employee, it’s clear that improving the employee experience can significantly impact the bottom line.

Yet, despite substantial corporate investment in this strategy, the percentage of engaged U.S. employees has remained virtually stagnant since Gallup began tracking it in 2000. Most engagement initiatives have been ill-defined and ineffective, incapable of providing the actionable insights necessary to enact lasting change. Many organizations still struggle to effectively engage their people, and employee quits have continued to outpace layoffs 2:1.

Fortunately, advancements in artificial intelligence are empowering executives to drive meaningful organizational change. These powerful systems can analyze unstructured data with better-than-human accuracy and are as sensitive to emotions as they are to statistics. Moreover, because machine learning is a key underlying tenet, these AI-powered solutions continuously and automatically improve without any outside interventions. This technology has exciting and far-reaching implications, and is guaranteed to impact the way we manage human resources.

Fostering Better Understanding

Two-way trust is crucial to building positive and productive work environments, but establishing and nurturing it within an organization can be challenging. To create a high-performing culture based on trust and communication, it’s imperative to first uncover employee sentiment and then respond appropriately. What’s more, according to the Center for Generational Kinetics, 75 percent of workers said they would stay in an organization longer if their employer listened to—and addressed—their concerns. Imagine the financial impact of a 75 percent improvement in retention!

Many organizations rely on the annual performance management process, but these once-a-year conversations can be limited in their ability to obtain quality feedback and insight into the employee experience. Instead, executives can leverage sophisticated pulse surveys, powered by AI technologies and capable of decoding open-ended surveys with exceptional accuracy.

These innovative solutions couple advanced natural language processing with machine-learning algorithms to analyze text-based responses and uncover not only what employees are saying, but how they actually feel—in real time. Armed with qualitative insights about what matters most to their people, executives can truly understand their motivations and take action to improve the employee experience.

Predicting Workforce Behavior

By identifying trends and anomalies, today’s AI solutions leverage unbiased mathematical algorithms to forecast future scenarios with tremendous accuracy. They can predict a variety of workforce scenarios, including retention risk, high-performance potential and even future engagement scores. These predictive solutions are part of a new generation of insight-driven tools that combine analytical and emotional intelligence to help organizations harness the power of big data and gain a competitive edge for the future.

Taking Strategic Action
Thanks to the actionable insights and analyses provided by pulse surveys and predictive analytics, leaders can take meaningful steps to improve employee satisfaction and increase business performance. Prescriptive analytics take these measures one step farther, offering fact-based, real-time suggestions at key decision points to assist employers in making their most crucial leadership decisions. Personalized recommendations for coaching, supporting or retaining employees are based on unbiased people data mined from demographics, surveys and previous HCM actions, making decision-making easier and leaving no room for favoritism.

By 2020, Forrester predicts that insights-driven businesses will win about $1.2 trillion a year in business from their less-informed peers. Today’s emerging AI tools enable leaders to have a powerful and measurable impact on their workforce metrics, and therefore everything else in the process—solidifying HR’s strategic role in the organization.